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PPE Used Incorrectly Half the Time, Study Finds

Poor compliance is ‘pervasive’

July 28, 2015

Nine months after a Texas nurse contracted Ebola from a patient and after a National Nurses United survey found that 85% of RNs reported that they had not been adequately trained to protect themselves from infection, researchers have found that training for health care workers using personal protective equipment (PPE) remains insufficient, according to an article posted on the HealthLeaders Media website.

Less than half of health care workers observed at a large Midwestern health system correctly removed their PPE, putting themselves at risk for infection, in a study published in the American Journal of Infection Control.

Although the study included only health care workers at the University of Wisconsin, Madison, it is likely that employees of other U.S. health care facilities are also improperly removing their PPE, said co-author Nasia Safdar, MD, PhD. In her opinion, the practice is “pretty pervasive in all institutions.”

Safdar added: “These breaches of PPE-removal protocol may be due to a lack of awareness of the proper procedure, time constraints, or lack of realization of the importance of proper PPE removal.”

Much of the problem stems from nurses, physicians, and other health care workers not being properly trained and then tested during their professional education, according to Sylvia Garcia-Houchins, RN, CIC, director of infection control at the University of Chicago Medical Center. “People modify the process for whatever works for them. Nobody is telling them this is the way it should be done.” Orientation for new employees at the University of Chicago now includes training and testing for the proper donning and removal of PPE.

The University of Wisconsin study was conducted by direct observation of health care workers using the Centers for Disease Control and Prevention’s (CDC) guidelines for PPE removal for contact isolation. The CDC recommendations state that health care workers should remove contaminated gloves first, followed by gentle removal of the gown from the back of the neck while in the isolation patient’s room.

The study’s observers checked to see whether health care workers took the following actions:

Removed gowns first

Removed gloves first

Removed gowns in a manner that was not gentle

Removed gloves in a manner that was not gentle

Properly disposed of PPE in the patient room

Disposed of PPE in the hallway

Removed PPE in the correct order

Removed PPE in the correct order

Wore PPE in hall

Removed PPE in the correct order but did so with flourish

Removed PPE in the correct order and did so without flourish

Removed PPE in the correct order and disposed of it in the patient room

The scoring was done by calculating the percentage of health care workers that performed the 12 actions above.

“We found that the majority of [health care workers] did not remove PPE in the correct order. Further, many of those who did remove the PPE in the correct order failed to properly dispose of their contaminated PPE in the isolated patient’s room. Deviations from protocol were common,” the authors wrote.

The poor compliance reveals that further education and collaboration with hospital and health care leaders to improve compliance is needed, Safdar said.

In response, the University of Wisconsin, Madison, has started reeducating its health care workers about how to properly remove PPE and its importance. The university is using teaching methods already in place at the hospital, including grand rounds discussions, infection control liaisons for each unit, and interactive education programs. The frequency of the training was increased, and all staff members are required to attend.

With the introduction of Ebola patients in the U.S., the University of Chicago began retraining staff on proper use of PPE, Garcia-Houchins said. “We practiced using powder and other substances to simulate the virus to show how correct removal of PPE protects against self-contamination.”

The ED staff went through three sets of training and had to prove that they were competent in PPE removal, she said.

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